No Amount of Alcohol Is Safe

Laura A. Stokowski, RN, MS

Disclosures

April 30, 2014

In This Article

Isn't Modest Drinking Cardioprotective?

Alcohol is a double-edged sword.[12] Two decades ago, studies that explored the "French paradox" began to appear in the medical literature and were also picked up as news by the mainstream media. Light to moderate alcohol consumption appeared to have a cardioprotective effect. According to observational studies, the French, who had the highest alcohol intake (particularly of wine), also had the lowest incidence of cardiovascular disease.[13]

John Q. Public, who may have viewed these results as a "get out of jail free" card, may also have ignored the "small print" that cautioned against alcohol consumption as a measure to prevent cardiovascular disease.[14,15] The evidence showing lower risks for diabetes mellitus, stroke, heart failure, and total mortality stand in stark contrast to the harms associated with excessive alcohol consumption.[13]

Another problem with the notion of alcohol's protective effect on cardiovascular disease is that this effect depends on a consistent light to moderate drinking pattern, without episodic heavy or "binge" drinking. The ideal pattern seems to be daily low- to moderate-dose alcohol intake (preferably red wine) before or during the evening meal, which is associated with the strongest reduction in adverse cardiovascular outcomes. However, more is not better; in fact, more is dramatically worse. Heavy alcohol use causes hypertension, atrial fibrillation, ischemic and hemorrhagic stroke, and nonischemic dilated cardiomyopathy.[13]

The evidence for the harmful effects of alcohol is stronger than the evidence for its beneficial effects. Moreover, the risk-to-benefit ratio of drinking appears to be higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently suffer the adverse consequences of acute intoxication (accidents, violence, and social problems). In fact, among males aged 15-59 years, alcohol abuse is the leading risk factor for premature death.[12]

And yet, other than celebrity drunk-driving stories, we rarely see headlines about the harm caused by alcohol. Dr. Rehm comments, "I do not know why a beneficial link would be more important than a detrimental link, if the beneficial link overall is about one tenth of the detrimental link. We have counted how many studies are reported in the press, and there are many more reports on the beneficial link than on the detrimental link between alcohol and health."

"The public's acknowledgment of the risk associated with an exposure depends on the strength of that relationship. Because 80%-90% of cancer deaths are caused by tobacco, the risk is common knowledge. If your neighbor dies, the first thing people ask is whether he was a smoker. The relationship of alcohol with other cancers, however, might be in the range of 5%-40%. So if your neighbor dies of breast cancer, people wouldn't ask whether she was a drinker."

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